• Aortic Insufficiency

    (Aortic Regurgitation; Aortic Incompetence)

    Definition

    The aorta is the main artery carrying oxygen-rich blood from the heart to the body. After each heart beat, the valve closes tightly to prevent blood from flowing backwards into the heart. Aortic insufficiency occurs when the aortic valve does not close tightly enough.
    Most people with slowly progressive (chronic) disease do not have symptoms and may not need immediate treatment. But, you should talk to your doctor if you think you have this condition. You will need to have tests and get proper treatment. Aortic insufficiency can also occur rapidly, particularly from infection or trauma to the aortic valve. This requires immediate medical attention.
    Aortic Valve Insufficiency
    IMAGE
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    Causes

    Aortic insufficiency can be caused by:
    Sometimes the cause of aortic insufficiency is unknown.

    Risk Factors

    These factors increase your chance of developing aortic insufficiency:
    • Family history of aortic insufficiency
    • High blood pressure
    • Use of drugs (eg, weight loss and appetite suppressant medicines)
    Tell your doctor if you have any of these risk factors.

    Symptoms

    These symptoms may be caused by other conditions. Do not assume they are due to aortic insufficiency. Tell your doctor if you have any of these:
    • Shortness of breath with activity
    • Exercise intolerance
    • Dizziness
    • Chest pain
    • Heart palpitations
    • Heart arrhythmia (irregular heartbeat)
    • Fainting
    • Difficulty breathing when lying flat

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done.
    Your doctor may pictures your heart. This can be done with:

    Treatment

    Treatment options depend on the severity and history of the valve leakage. It also depends on its effects on the heart’s size and function. Talk with your doctor about the best treatment plan for you.
    The immediate treatment depends on how severe the symptoms are. Surgery is needed in severe cases. In chronic and slowly progressive aortic insufficiency, treatment may involve taking medicine.

    Medication

    Medicines cannot fix the valve, but they can be used to treat aortic insufficiency. Medicines used may include:
    • Diuretics—to treat high blood pressure and rid the body of excess fluids
    • Calcium channel blockers—to reduce leaking and, in some cases, delay the need for surgery
    • High blood pressure medicines (eg, angiotensin converting enzyme inhibitors [ACE inhibitors], angiotensin receptor blockers)
    • Antibiotics used before dental and surgical procedures to prevent infection
    Depending on your condition, your doctor may schedule routine physical exams and echocardiograms.
    If the condition is rapidly declining, surgery is needed.

    Surgery

    There are several open heart surgeries that can fix leaking valves. The type chosen will depend on the nature of the valve and the expert recommendation of the surgeon. Generally, the valve will be repaired, rather than replaced, with an artificial valve.

    Prevention

    In most cases, this condition cannot be prevented. Ask your doctor if you should take an antibiotic before dental and other procedures. This can help to prevent infection.

    RESOURCES

    American Heart Association http://www.heart.org/

    National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/

    CANADIAN RESOURCES

    Public Health Agency of Canada http://www.phac-aspc.gc.ca

    Heart and Stroke Foundation of Canada http://ww2.heartandstroke.ca/

    References

    Aortic regurgitation. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 10, 2012. Accessed November 7, 2012.

    Aortic valve stenosis (AS) and aortic insufficiency (AI). American Heart Association website. Available at: http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm%5F307649.pdf . Published 2009. Accessed November 7, 2012.

    Coarctation of aorta. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated June 28, 2012. Accessed November 7, 2012.

    Congenital heart defects. Nemours Foundation website. Available at: http://www.kidshealth.org/parent/medical/heart/congenital%5Fheart%5Fdefects.html . Updated January 2012. Accessed November 7, 2012.

    Scognamiglio R, Rahimtoola SH, Fasoli G, Nistri S, Dalla Volta S. Nifedipine in asymptomatic patients with severe aortic regurgitation and normal left ventricular function. N Engl J Med. 1994;331:689.

    What are congenital heart defects? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/chd/chd%5Fwhat.html . Accessed November 7, 2012.

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